| ObjectiveAlong with the aging of population and the vast improvements in life expectancy,more and more octogenarian patients are being diagnosed with esophageal cancer.Compared with young patients,octogenarians with esophageal cancer typically have a poor physical condition,and high postoperative mortality(POM).Lymphadenectomy is an important part of radical operation for esophageal carcinoma.Extensive lymph node dissection could reduce tumor recurrence and improve long-term prognosis,on the other hand,it could increase surgical trauma and postoperative complications.The purpose of this study was to examine the associations between the number of dissected lymph nodes and short-term and long-term postoperative outcomes in octogenarians with esophageal cancer.And the conclusion could provide theoretical foundation for lymph node dissection in octogenarians with esophageal carcinoma.MethodsWe included octogenarians with esophageal carcinoma who received radical operation with lymph node resection from the SEER database between January 1,1998 to December 31,2016.According to the number of lymph node dissected,we divided patients into two groups:group A(examined 1-14 lymph nodes)and group B(examined ≥15 lymph nodes),respectively.The POM and long-term survival after radical operation between the two groups were analyzed.Univariable and multivariable logistic regression analyses were performed to identify predictors of POM.Kaplan-Meier analysis was used to draw the survival curve,and the Log-rank test was performed.Cox proportional hazards model was used to identify independent risk factors for long-term prognosis.Results1.A total of 213 octogenarians with thoracic esophageal cancer who underwent esophagectomy with lymph node dissection were included in the analysis.A total of 140 patients(65.7%)had 1-14 lymph nodes resected,while 73 patients(34.3%)had≥15 lymph nodes resected.The POM at 30,60 and 90 days among all 213 octogenarians with esophageal cancer after esophagectomy with lymph node dissection was 8.9%,15.5%,and 20.2%,respectively.The 30-day POM rates were 10.0%and 6.8%,the 60-day POM rates were 16.4%and 13.7%,and the 90-day POM rates were 20.7%and 19.2%for patients with group A and group B,respectively.There was no significant difference in POM between the two groups.According to logistic regression analysis,the number of lymph nodes dissection was not significantly associated with POM(P=0.791),while age(P=0.012)and marital status(P=0.013)were independent risk factors for POM of octogenarians with esophageal cancer.2.The median overall survival(OS)time was 15 months,the 3-year and 5-year OS rates were 36.9%and 28.8%among all 213 octogenarians with esophageal cancer.The median OS time was 15 months for patients with group A and 20 months for patients with group B.The 3-year OS rates of the two groups were 38.2%and 34.8%,and the 5-year OS rates were 28.8%and 26.5%,respectively.The survival difference between group A and group B was not statistically significant.Log-rank test showed that the number of lymph nodes dissection(P=0.831)was not significantly associated with long-term survival.According to Cox proportional hazards model analysis,marital status(P=0.035),pathologic T classification(P=0.015)and N classification(P=0.001)were the independent risk factors for the long-term survival in octogenarians after esophagectomy.Conclusion1.The extensive lymph node resection may not increase POM in octogenarians after esophagectomy,and not improve the long-term prognosis.2.Age and marital status were independent risk factors for POM in octogenarians with esophageal carcinoma.3.Marital status,pathologic T classification and N classification were independent risk factors for long-term survival in octogenarians with esophageal carcinoma.4.Octogenarians may not benefit from extensive lymph node dissection.For lymph node dissection of octogenarians with esophageal carcinoma,flexible dissection strategy should be formulated according to preoperative imaging examinations. |
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